Quality of life in older adults with aortic stenosis: a narrative review

Background
Aortic stenosis in older adults can lead to symptoms of breathlessness, dizziness, syncope and angina. While surgical AVR is the optimum treatment, it is not suitable for frail older people who may have other significant comorbidities. TAVI provides a safer alternative. There is evidence that aortic valve replacement reduces mortality and morbidity, but less is known about its effect on quality of life (QoL) in older adults.

Aims and objectives
To carry out a narrative review of the existing literature on quality of life (QoL) after surgical aortic valve replacement (AVR) or transcatheter aortic valve replacement (TAVI) with the aim of identifying what is known about QoL pre- and postvalve replacement.

Conclusions
There is some evidence that QoL improves after aortic valve replacement, but there are significant gaps in our knowledge. There are no studies that compare QoL after TAVI vs. surgical AVR; thus, we do not know the relative effect of the different procedures on QoL. The literature does not adequately explore why some people have improved QoL after aortic valve replacement and others do not. There appears to be some evidence that the existence of comorbidities may negatively influence QoL after valve replacement, but there is not enough consistent data on comorbidities to explore this further. Study designs are heterogeneous and prevent any meta-analysis of findings.